Blue Beryl Blog

“I began to understand that what I could not open to in myself, I would shut out in others. This is just the way it seemed to work. The open heart so prized in Buddhism, a heart that is ready to take in the suffering of others, did not seem to open wide enough if it had not first been opened to one’s own suffering.” - Pilar Jennings.

With some dense or challenging material, Pilar Jennings “To Heal a Wounded Heart” offers a touching and readable account about healing nat the crossroads.

Dr. Jennings, an analyst whose lectures I have attended, brings us into the vibrant silence of a young girl of the age of six, who has stopped speaking.

Silence can be a protective barrier, a hand up to demarcate the boundaries of unreliable social world and a private internal world.

This stark response to a chaotic world, with unpredictable comings and goings, marked by repeated loss and neglect, reflects relational wisdom and demonstrates a form of agency.

communicated nonverbally, especially when it comes to children, along with the rightful indignation when basic needs are not met.

In those early developmental years, we are processing so much information, subtly attuning to emotional ways and social rules.

Our growth is rapid, but it can also be forced, haphazard or arrested. We learn trust, intimacy and resilience and our ability to communicate around those enduring needs and skills, which then inform our adult schemas.

These patterns — both our own, and transmitted intergenerationally — become muted and mutated, in the unique social contexts of our upbringing.

Jennings invites us, also, into the human world of her friend and Buddhist teacher, Lama Pema Wangdak. Lama Pema is brought into this intimate setting, mirthful and with at least a few lessons about happiness in the face of extreme loss and suffering.

He appears to have an uncommon ability to reflect a basic sense of worthiness, a value that is often challenged in circumstances of neglect. The sense of humor, recorded, is what made parts of this work a page-turner.

While not being good enough or not being worthy of love are often the delimiting self-talk we may be accustomed to, such diatribe can be rooted in early neglect and loss.

We are often likely to experience a rift - like that of the grand canyon. On one side, a ground of self-worth that is the basis of human experience, demarcated by a chasm of self-doubt carved by glaciers of relational wounding.

Analytic insight and contemplations on Buddhist wisdom are woven into this work, sensitively. It avoids idealization, projections and issues of bypassing and reveals the connection that three lives – that of analyst, Buddhist monk and young patient have suffered through and been transformed by – isolation, loss and perhaps, neglect.

This playing field has been leveled. No one is really more special here. Everyone has gone through something, and but are at different stages.

What is really salient are those scars, wounding the transformative value of aspects of our experience that have begun to resolve and shape our wisdom in the present.

The monk also appears to express resentment, perhaps not bitterness. He has lost country and family, siblings and home, the innocence of youth. Where is the recognition that we all need as young children? How is this sublimated in his religious upbringing, offers a profound reflection.

They – therapist, monk and patient - are not all resolved, but are they happy? Still dealing with anxieties and human frailties, but held with a wisdom - which becomes the question of , is happiness a choice? What does it take to be really happy?

A common theme throughout is one of connection, family and incongruent paths that seem to fall together naturally. Who is your sangha? What social contexts holds together the pain and healing. These are not deliberately asked, but gently placed. Skillfully placed, like mindful attention and the blooming of insight.

Dr. Jennings introduces a relational perspective on meditation.

An approach that has evolved from the work of Ainsworth and Bowlby, and perhaps out of the strictures of familiar psychoanalytic molds, through a foray into Jung, and I believe intersubjective, neuroscience and attachment theory. Jennings offers a personal glimpse into the dharma, a Buddhism recontextualized amidst the beauty and banality of New York.

She speaks personably about her own upbringing, the wounding by her parent’s divorce, years of analysis and therapy, as well as some degree of respite found in her contemplative calling and academic inquiry. The work also showcases play therapy in the early years of a budding therapist. This is her first client, I believe, and we find some of her early intuitions to also reflect some of the naturalness we come around to, years and even decades later perhaps.

Some of our sufferings are primarily relational. Patterns of relationship, around attunement, security and connection contribute to our often unacknowledged ways of being in the world and with others.

Neuroscience and mindbody medicine look more keenly at how our early histories impact physiology and emotion regulation.

We come to embody our wounding as a path toward change.

No spoiler alert, but this story does not have perfect ending. The wise Buddhist monk is not the only teacher. Perhaps it is the relational context - with all the quirkiness of the human condition, humor, differences and things which just don’t make sense, that will relay that intrinsic healing wisdom – point it out.

I believe we can learn a lot by glimpsing how others let go or transform their suffering, all the while acknowledging that one’s own way and wisdom is necessarily unique. To witness the commonality of trauma, suffering, loss or even resentment – our ‘coping wisdoms’ - all aspects of the human journey. To have it held and to be seen…

Good books like this are not really about psychoanalytic theory – or about the author, the monk, or the young girl we want to know more about – probably an adult, now. They are about isolation, and whether there is someone in our lives we can reach out to. They invite the reader into a level playing ground, so that conversation and sharing around what is essential, or painful, can begin.

The epidemic of silent suffering around mental health needs to be addressed. What I liked particularly about this work is the wicked sense of humor that carries one through muddy waters, above the stylish and sharp narration.

Jokes go along way in mending – loss. They can fill the space -- the vibrant empty field of the heart -- with a sense of profound possibility.

I am as concerned about the rising status of depression in our society as the next. Providing effective care for those suffering with depression, through Chinese medicine, is a top priority.

Prof. Edward Bullmore of Cambridge puts forth some novel hypothesis around the role of inflammation in the causation of depression (Inflamed Mind, 2018). His recent work, meant for a popular audience, articulates the hopes for an emerging field – that of “neuroimmunology” – while highlighting the drawbacks of certain approaches to the care of major depressive disorder.

Bullmore tackles the mind-body problem, and the issues of characterizing depression as a disorder solely of the brain, or of being “in the mind alone,” as well as the limited success of treatment through SSRI’s. Each of these demonstrates a faulty or shadowy understanding of the mechanisms underlying depression.

He offers up flaws in our popular understanding of the blood brain barrier, which we have been taught to see as a “wall” between the brain and the immune system. The question of inflammation and it’s role in the causation of depression is also a glossed comment a broader inquiry into immunology. In addition, he also discusses in brief vagal stimulation as a potentially promising treatment consideration. Research in both areas can be appended to his general scope of argument, including our expanding understanding of the gut (microbiome) and the brain.

Main question – can we assume that inflammation underlies depression? For one, Bullmore notes that the diagnosis of MDD (Major Depressive Disorder) is challenged by comorbidity – that another, often physical disease may be present, one’s that may also involve inflammation.

Causation is difficult to prove.

He notes a number of instances such as the use of interferon, vaccinations and cites anecdotes where a rise in inflammation appears to correlate with depressive episodes. For many, the examples ring as common sense truth.

What a work such as Inflamed Mind offers is a glimmer of hope. We don’t find strongly, citeable evidence, but rather a window into a realm of hypotheses that asks us to widen our treatment considerations. Underscoring the role of social stress, its relation to inflammation and a potential relationship to depression, we again recognize the socio-cultural context of disease (156).

There are as of yet, no treatment options for really tackling depressive disorders with anti-inflammatory medications, nor clinical trials to back such approaches. Just as serotonin deficiency, tests for inflammation lack appropriate bio-markers that can be viably tested for. Bullmore makes this clear and simple for the reader.

These theoretical insights are perhaps best amalgamated into a clinical or therapeutic perspective that accounts for depression, along with other threads of causality to link valuable options. Prof. Bullmore is clear there is no panacea, and in talks online (youtube), we find ourselves looking as well at behavioral and more responsible approaches to self-care, absent of a distinct anti-inflammatory medication that will directly address the “inflamed mind.”

You will not find in Chinese medicine, a clear cut connection between inflammation and depression. In modern Chinese medicine, one might not extract a distinct model of causation that highlights the social context of disease – but rather, the clinical presentation, whose many shades lend to organic causes of disease.

In a way, zang zao syndrome or ‘visceral agitation’ is one reflection of mental-emotional disorders that maintain a distinct somatic causation, that mirror the notion of an “inflamed mind.”

Undoubtedly, we recognize stress and inflammation in ourselves and our clients, and in contemporary practice, along such findings as a dusky or dry red tongue, and clear signs of inflammation in the soft tissue.

I certainly agree with the implications of the author that we have to look directly at the rise of incidence of depression and alzheimer’s, through the lens of inflammation. I’ve genuinely emphasized the reduction of pro-inflammatory foods and lifestyle, for the long haul, as preventative measures. We often cannot foresee what illnesses will present, but we can take care of stress and better understand epigenetics.

Often it’s the perfect storm, that delivers the message of illness. We might simply do best to continually prioritize health, and make the healthier choices that are available to us.

Among the most salient features of contemporary Chinese
medicine tongue diagnosis is the topographic mapping of the body’s interiors upon the tongue surface. As if it
is a diagram, we can look at the tongue body and coating and gather useful
diagnostic criteria.

Again, two recently published tracts – one by Iannis Solos
(Gold Mirrors and Tongue Reflections), include translations of two seminal
texts, and another, a dissertation by Nancy Holyrode-Downing, explores the
history of tongue diagnosis from the Han Dynasty to the present era. The former
includes a variety of tongue images not commonly seen – both choose not to
focus on the findings of a relatively recent and influential stream of
knowledge from the Warm Disease (Wen Bing) current of Chinese medicine.

Two protagonists of this current of Chinese medical thought
contributed much to our understanding of epidemic and febrile diseases. They
are Wu Ju Tang and Ye Tian Shi – both of the Qing Dynasty. Perhaps what’s
relatable here is that the Warm Disease school is associated with many of the
heat conditions that we see in the warmer months, and which are particularly
relevant to illnesses that occur from spring to late summer, including
dermatological conditions, and dampheat lodged in the body’s interior.

Wu Ju Tong classified illness according to Three Burners – the upper respiratory,
the digestive, and the urogenital. Of course, these are not their proper names
for the upper, middle and lower burners.

If you look to a tongue, at quick glance you can divide the
tongue body into three vertical sections, and narrow down pathology based upon
what appears in those three divisions. If you notice chronic symptoms in the
organs of a specific burner, you can see if you notice any changes in color or
coating in one of those sections.

“Use herbs that are as light as the feathers of a bird for
disease in the upper burner; use herbs to lift the Spleen qi and cause the
stomach qi to descend in the middle burner, just like calibrating a scale that
should always be in balance; and use heavy and cloying herbs to treat yin
deficiency for the Liver and Kidney in the lower burner like adding a heavy
weight to a scale to tip the balance.” – Wu Ju Tang

Ye Tian Shi offered a framework called the four levels, which reflects the impact
of heat pathogens, often viral/bacterial in nature, upon the body dynamic. For
those, the color of the tongue body and certain markings or presentations,
alerts us to the severity of the disease transmission, and differentiating
properly is a big deal as the nature of a pathogen is specified from the outset
in Chinese medical diagnosis.

Actually, for quite a variety of skin conditions – such as
eczema, psoriasis, dermatological presentations that involve macules, papules
and blisters – this realm of diagnostic knowledge is indispensable. It’s common
for a modern herbalist to view medicinals according to apparent pharmacological
properties – such as antipyretic, antiviral or antimicrobial – without
acknowledging how they function according to the extensive, empirical knowledge
relative to, for instance, the stage of progression of such conditions.

There are very specific differentiations. A modern herbalist
may lump herbs together, not knowing that herbs also harness the body’s
intelligence into strategies; or paradigms of healing, perhaps. The outcome is
that to the trained eye it’s like forcing break dancing to polka music.

Which brings us to consider the variety of information that
these different texts and contexts have to offer.

In modern Chinese medicine, we regard the sides of the
tongue as indicative of the state of the liver/gb, the tip and top 1/3 to the
heart and lungs; the center to the spleen stomach and the lower 1/3 to the
kidneys, large intestine, urogenital organs, etc. It’s not entirely clear when
these derivations were solidified, but they have mostly been accepted.

·In addition to these significations, we look to
the color – color being a main
indicator of the nature of imbalance. What would red signify – heat, generally. Pale color – a lack of blood or qi. A
very common color is called ‘dusky’ – often regarded as purple, or pale purple and
amounts to stagnation.

·We also look at the size and shape. For example, puffy can sometimes imply dampness, or
a lack of yang qi by which warmth is distributed. Sometimes the tongue body can
be stiff, short, upturned, downturned, off to the side or quivering. These are
all facets that we assess.

·What about under the tongue? Distended
sublingual verici often denote blood stasis.

·What about the coating? Is it fresh, or perhaps
dry or grey? Is the taste in the mouth sweet, sticky, bitter, or off? These are
important indicators. A thin white coating is normal. Sometimes the body’s yin
can be lacking and we see a geographic tongue, which is called peeled. There
will be areas without coating.

I think this level of information can be had by searching
the web, and can be useful.

The classics referred to in the above works hardly reflect
any of these generalizations. They address specialist findings relevant to the
school of Cold Damage, known as ‘Shang Han.’ Again, these translated texts were
circulated around the 13th to 14th century flesh out
tongue images that broaden the clinical presentations, for which pulse
diagnosis and symptom/sign presentation were well-established.

What’s most relevant to these are specific stage-like
presentations of acute, or chronic diseases noted in the earliest of Chinese
medical lore. There is less of an emphasis upon specific organ systems, as the
nomenclature and disease models are different in these contexts.

What you do find is a much more specific line of medical theory,
which moreso, might indicate not that there is “dampheat in the liver/gallbladder
(area}” and someone has been leaning on “food and drink,” but moreso about
progression, i.e. whether a condition/individual would benefit from sweating
(diaphoresis), or purgation, for example if heat is trapped in the body and can
be evacuated down and out.

When speaking of external pathogenic factors – we rely on
concepts of wind, cold, heat, dampness, dryness and fire – each of which have
been treated from different medical models throughout the centuries.

So again, what we see in contemporary tongue diagnosis is
the synoptic quality of body mapping,
and we often take for granted how such images took on the interpretive significance
we assume through modern, institutional learning. There’s so much wisdom packed
into a generic imaging of the body that has to be astutely sifted through.

You can take things at face value, or recognize there are
interpretive depths to just about anything – like routine bloodwork.

To respond to this question, what we can see from the tongue
(or the pulse for that matter) can be rather nuanced, or quite generalized.
Such is the beauty, or obscuring nature, of modern Chinese medical knowledge.

It all depends upon what you need to know, and how you are
looking. Sometimes a quick review or glance is sufficient. Other times you are gaping
at a tongue or pulse for a while, which can make some of my seniors or
pediatric patients, giggle.

While tongue diagnosis is a part of the panoply of
diagnostic methods, its also a window into the world of medicine, with
superficial features and exteriors, as well as a rich and complex depths of
inquiry and understanding.

“What do you learn from the tongue?” “What does the tongue
inform you?”

I commonly receive
this question amongst new or inquisitive patients, and on occasion request that
they examine the tongue to begin to make connections and better understand their
health status. I recall my first notable presentation – my own tongue!

One celebratory evening, a colleague of mine of native
descent invited me for dinner. After over a decade of very scrupulous vegan and
vegetarian diet, I was offered food prepared after a hunt he and his relatives
had gone on.

I obliged. And it was a personally meaningful and powerful
exchange and experience, and I had a night full of vision-filled dreams.
Though, when I woke up I also had a somewhat uncommon tongue presentation. The coating
was black – seemingly dark and charred, a sign that might indicate heat toxin,
or a type of toxic response, from the Asian medical perspective.

In actuality, we find many interpretive depths around tongue
presentations, in clinical practice, and in the literature. What may be severe
or illustrative in one context, may lack such significance in others.

Recent scholarly monographs (Solos, 2013), and a
dissertation (Holroyde-Downing, 2017) we’ll review for you, explore the history
of tongue diagnosis from the premodern era up until the present. One of the astonishing
insights they provide is the historical development and inclusion of tongue
diagnosis.

Among these textual/historical findings is the tracing of
key passages from canonical literature such as the Inner Classic (Nei Jing), to
the inclusion of diagnostic signs in texts on Cold Damage (Shang Han). We find
that the tongue is associated, for instance, with visceral systems such as the heart
(xin), but also in epidemic diseases
due to external contraction.

Indeed, the author of Gold Mirrors and Tongue Reflections,
a key translation of two seminal texts that are foundational to tongue
diagnosis, reveals how contemporary interest arose with serious epidemics –
especially around 13th century, and more recently – with the SARS
epidemic that arose in the early 2000’s.

That epidemic diseases was a key force contributing to the
focus on this form of “looking diagnosis” reveals how tongue diagnosis is
especially helpful for understanding the progression of a disease process due
to an “external contraction,” which we often relate to viral pathogens, and the
like.

We gain a reflection of how a disease process is
progressing, affecting the “interior” of the body.

What a tongue tells is context dependent.

We can look to a tongue and examine the “shen” which refers
to the spirit, the liveliness or even constitution strength of the individual.
This can be revealing also for prognosis. If the spirit is strong, and there is
healthy sheen, the more superficial findings of the tongue can be seen as
secondary – manageable.

In future discussions, we’ll highlight some cross-disciplinary
and cross-cultural observations of the tongue. As with any diagnostic method,
there is a great deal of interpretive variation. One might suppose that the
canonical investigations should be at the forefront, and leave aside
contemporary Chinese medical frameworks. But this could be delimitating.

Contemporary models can be largely reductive – or synoptic.
They may gather information from disparate contexts to assemble an integrative
tongue picture. In one context, such as fertility or dermatology – a clinician
may pause briefly to examine key, relevant features that are significant to
their discipline. In the case of epidemic diseases, the color of the tongue
body, certain markings and the state of the tongue coat will take on another
level of significance.

Lastly, from the cross-cultural perspective we can appreciate
the tongue as a map of the body, with specific regions of the tongue relating
to different organ systems, and that the tongue coating, emerging from the
fluids of the stomach and as a mirror of the digestive system – these are
almost universally similar.

So if we are examining the tongue, these are some of the
principal features we are looking at: the overall appearance, the shape, the
constitution, regional variations, coating and the colors that arise in these
features that reflect different factors of imbalance, or reflect health!